[Transinguinal preperitoneal mesh-plasty (TIPP) in management of recurrent inguinal hernia]

From 3 years' experience with nearly 100 transinguinal preperitoneal mesh prosthesis (TIPP) repairs for recurrent inguinal hernia the indication, anesthesia, modification of the technique, and results are reported. After intraoperative classification of the hernia, the TIPP repair is indicated especially in large defects of the posterior wall (L/M III). The procedure is easily performed under local anesthesia. During 52 local TIPP repairs, conversion of anesthesia was never necessary. Important technical details include the requirement for a sufficient size of mesh (10 cm x 15 cm) and a certain caudal and cranial fixation of the prosthesis using at least three interrupted stitches for each. Apart from an increased number of seromas (12%) in the early postoperative period, the results of the TIPP are comparable with those obtained after Shouldice repair for recurrent hernia. The rate of hematomas, infections, and testicular complications range between 1% and 3%. Considering the negative case selection of only large recurrent hernias, the TIPP repair reveals a favourably low 1-year recurrence rate of 1%.